嵌顿性输尿管结石不同治疗方法效果分析  

Analysis of different treatment methods for impacted ureteral stones

作　　者：王鑫[1] 欧阳骏[1] 

机构地区：[1]苏州大学附属第一医院泌尿外科,江苏苏州215006

出　　处：《临床泌尿外科杂志》2014年第4期324-326,329,共4页Journal of Clinical Urology

基　　金：国家自然科学基金资助项目(编号81070591)

摘　　要：目的:比较开放性输尿管切开取石术(UL)、腹腔镜输尿管切开取石术(RLU)及逆行输尿管镜碎石术(URL)治疗嵌顿性输尿管结石(IUS)的疗效。方法:回顾分析150例嵌顿性输尿管结石患者的临床资料,其中男82例,女68例。根据手术方式随机将患者分为UL组和RLU组以及URL组,分别比较两组之间一次手术成功率、手术时间、术中出血量、术中出现输尿管穿孔,撕脱,大出血、术后住院时间、术后双J管拔出时间、结石清除率、及术后出现输尿管狭窄发生率。结果:三组患者在年龄、结石长径、梗阻位置、梗阻时间上无统计学意义,UL组和RLU组在一次手术成功率、手术时间、术中出血量、术中出现穿孔、撕脱、大出血、双J管拔除时间、结石清除率及术后输尿管狭窄发生率上差异无统计学意义(P>0.05),而在术后住院时间上,RLU组要明显优于UL组(P<0.05)。URL组与UL组及RLU组在手术时间、术中出血量、术后双J管拔除时间上差异无统计学意义;而在术中出现输尿管穿孔、撕脱、大出血、术后出现输尿管狭窄上,URL组发生率要明显高于其他两组(P<0.05)。一次治疗成功率:UL 100%,RLU 95.5%,URL 87.2%。术后2个月结石清除率:UL 100%,RLU100%,URL 74.5%。结论:在嵌顿性输尿管结石治疗方面,URL组与RLU组及UL组在手术时间、术中出血量、术后住院时间、术后双J管拔除时间差异无统计学意义,而术中出现并发症及术后输尿管狭窄发生率上URL组明显高于RLU组与UL组。RLU组较UL组在手术时间、术中术后并发症方面差异无统计学意义,但具有手术创伤小、术后恢复快的优点,有条件的医院可优先考虑采取RLU。Objective： To evaluate the efficacy of open ureterolithotomy （UL）, retroperitoneal laparoscopic ureterolithotomy （RLU）, and retrograde ureteroscopic lithotripsy （URL） for the treatment of impacted ureteral stones. Method： A retrospective analysis of clinical data of 150 cases diagnosed as impacted ureteral stones was taken. All patients including 82 males and 68 females were divided into three groups： UL group, RLU group and URL group. Clinical data including success rate on one session, operative time, blood loss, intraoperative ureteral perforation, avulsion, bleeding, postoperative hospital stay, postoperative double-J indwelling time, postoperative ureteral stenosis and stone clearance rate were statistically analyzed. Result： Three groups of patients in age, stone diameter, obstruction location, time of obstruction showed no statistical significance （ P 〉0.05）, but in the post- operative hospital stay, RLU group was significantly shorter than UL group （ P〈0.05）. There were no signifi- cant differences in operative time, blood loss, postoperative double-J indwelling time among these three groups, while in incidence of the intraoperative ureteral perforation, avulsion, bleeding, postoperative ureteral stricture on URL group were significantly higher than the other two groups （ P 〈0.05）. The success rate of URL, UL and RLU were 87.2%, 100% and 95.5% respectively. Two months after operation the stone-free rate of URL, UL and RLU were 74.5%, 100% and 100% respectively. Conclusion.. In the treatment of impacted ureteral stones, there are no significant differences in operative time, blood loss, postoperative double-J indwelling time and post- operative hospital stay among three groups, while in the incidence of intraoperative ureteral perforation, avulsion, bleeding and postoperative ureteral stricture, URL group were significantly higher than the other two groups. However, there are no significant differences in operative time, blood loss, intraoperative ureteral perforation

关 键 词：嵌顿性输尿管结石 腹腔镜下输尿管切开取石术 输尿管切开取石术 逆行输尿管镜碎石术 输尿 管狭窄 

分 类 号：R693.4[医药卫生—泌尿科学]